Patient satisfaction and quality of life in cancer outpatients: results of the PASQOC study.

BACKGROUND: Satisfaction with care and quality of life (QoL) are indicative of the quality of care of cancer patients. The purpose of this study was to lay a cornerstone for patient-centred quality management by assessing the current status of satisfaction with care and QoL among oncological outpatients in Germany, and by identifying the key factors that determine a patient's willingness to recommend a medical facility. PATIENTS AND METHODS: A self-constructed and validated patient satisfaction questionnaire plus the SF-36 were distributed to a random sample of 3384 cancer patients who presented at 24 investigators' offices nationwide within a defined recruiting period and who met the inclusion criteria. The return rate was 81.9% (n=2772). A total of 2659 (78.6%) questionnaires were evaluable. The most common cancer types were breast (22.9%) and intestine (19.8%). RESULTS: Overall satisfaction was high, but specific reporting questions revealed many areas for improvement such as shared decision making, doctor-patient communication and organization of care. QoL was significantly impaired in many domains. Patient-provider relationship, facility setting and information on diagnosis and treatment options are major determinants of a patient's willingness to recommend a facility to a friend or relative if needed. CONCLUSIONS: This multicentre study focusing on patient perspectives highlights that, although the overall degree of satisfaction was quite high, there are numerous areas for improvement.

Some comments on the use of statistics in the evaluation of drug trials in migraine.

Statistical aspects need particular attention in reporting on drug studies in migraine. It is important to report on all patient and disease characteristics which have contributed to the diagnosis and on all variables used for the evaluation of the result; the use of median values, accompanied by the extremes, is recommended in this context. Comparability of the study groups should be examined and possibly repeated after exclusion of the defaulters, if their number is substantial. As regards the presentation of the results, it does not suffice to give p values only: the magnitude of the response should be given and the use of techniques estimating the reliability of this magnitude (e.g. confidence intervals) and/or its reproducibility (e.g. power calculations) is recommended. An analysis of three unrelated groups of migraineurs demonstrates that most pertinent variables show a non-Gaussian distribution, and this includes the distribution of treatment results. For this reason, the use of nonparametric tests is advocated.

The acute antihypertensive effect of ketanserin increases with age.

The relationship between the acute blood pressure lowering effect of ketanserin with age was investigated in 57 patients ranging from 25 to 90 years (mean 61 years). There was a highly significant correlation between the degree of reduction of systolic and diastolic blood pressure and age, independent of the starting blood pressure. The fact that the acute blood pressure-lowering effect of ketanserin increases with age may suggest a role for serotonin in blood pressure regulation, particularly in elderly patients.